COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

W.O.# NW1-2338028 Tanknology Inc. 11000 N.MOPao Expressway,Suite 500 Austin,TX 78759 (800)964-0010 Policy 100-29-A .IOB CLEARANCE FORM& Rev:F SITE SAFETY CHECKLIST—OVF Revised:3/05/2018 Site Name/#: Street Address: tl jp r Pe�lunJ A W.O.R -r 1��D sll c,- 7-S U�7Z Arrival Time: Departure Time: Travel Time: others on site: Date U,-O [.'od -2-7—r Scope of Work and Tasks Performed(JSA's must be avai lab;e Tor all tasks): U�rr yr /�sSusc c�ftC Repairs to Equipment or Parts Provided: Follow-up actionsrequired;equipment isolated;comments: Po PPE-PERSONAL PROTECTIVE EQUIPMENT REQUIRED(Check-items used or mark--if notapplicable) Safety Vest W- Safety Glasses Gloves ❑ Hearing Protection Steel Toe Boots ❑ Splash Goggles ❑ Hard Hat ❑ Other r/ PRE-TEST PROCEDURES Check ✓each item com feted or mark N if notapplicable) 1. Discuss safety procedures with site personnel. Nearest hospital_ 2. Prior to fuel deliveries the UST system must be placed back into working order. 3. )l Secure entire work area with barricades(cones,flags,and extension bars,caution tape,pennant flags,or other perimeter guard). 4. 7 Place fire extinguishers and"No Smoking"signs in the work area. 5. Implement LockoutlTagout per API 1646(when accessing product piping during tasks) ❑ Secure nozzles with"Out of Service"bags and nylon ties. ❑ Secure the circuit breaker(s)with lockout devices and tags. ❑ Close ball valves or check valves on product piping. ❑ Disconnect electrical"bayonet'connector from the STP(s). ❑ All applicable equipment disabled during test(s). ❑ Verify LOTO is complete by trying to operate pumps. SIGN IN Lead Technician Name Lead Technician Signature General Safety Checks: All site personnel have been informed. O Fuel delivery has been Informed. Site Representative Name Site Represe f ve Signature e Is a fuel delivery due today? i LOTO procedures have been discussed and agreed. Work areas barricaded to protect workers,staff&public. u ave discussed job clearance form with technician. ✓ POST-TEST PROCEDURES(Check✓each item completed or mark — if not applicable) 1. ❑ Remove all"LockoutlTagouf devices, 2. ❑ Run all pumps and verify there are no leaks: ❑ Impact Valve Test Ports under dispensers ❑ Leak Detector Threads on STP's ❑ Functional Elements&Relief Screws 3. ❑ Install lead wire seal on all test plugs&leak detectors that were serviced. Count LD threads: L1_ L2_ L3_ L4_ L5_ L6 4. ❑ Check following components operational ❑ ATG probes,sensors,&caps Ball floats,dry breaks&caps [I Cathodic protection operational ❑ Containment sumps are dry ❑ Dispensers&POS operational ❑ Dispenser panels are replaced ❑ Drop tubes,fill adapters&caps ❑ Leak detectors&vent tubes I] Manhole covers and sump lids ❑ Monitoring system is operational ❑ Shear valves are open ❑ Siphon lines and manifold valves ❑ Spill containers&drain valves / ❑ STP fittings and bayonet connectors El Vents(not capped,plugged or isolated) 5. I Remove barricades. SIGN„OUT&Operator Verification of Work(OVF) Lead Technician Name Lead Technician Signature General Safety Checks: Work area has been left tidy&safe. ce Site staff are aware of work status including any remaining isolation. SE a Repr sentati a Name site a Egnalure Changes to equipment are documented and communicated. ' I I, All incidents,near incidents,and unsafe situations reported. /��I /4 Site Representative Comments: COMPANY CONFIDENTIAL. Q Tanknology Inc.,2018.All Rights Reserved. Tinted copies of this document are uncontrolled The current version is available in the Tanknology On-Line Document Control System.